Individual mandate upheld: What does that mean for you and your health?

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What does health care decision mean for doctors, patients?

Drs. Siegel and Samadi weigh in

Now that the Supreme Court has upheld the individual mandate clause of the Affordable Care Act (ACA), what does that mean for you as a patient?

While not validated under the commerce clause – the part of the Constitution that grants Congress the power to regulate commerce among the States, the Supreme Court has ruled that the mandate is constitutional under the government’s power to tax the population. According to the mandate, individuals will be required to purchase health insurance regardless of their situation.  Those who fail to purchase insurance will face the risk of paying a financial penalty.

The ACA – more commonly referred to as Obamacare – has many more provisions that will go into effect along with the mandate over the next decade.  While you may not see the changes overnight, within the next five to 10 years, your experience with your health insurance and your doctor will start to change.

The other notable provisions of the ACA include: prohibiting insurers from discriminating against those with pre-existing conditions, expanding those who qualify for Medicaid to include people and families making up to 133 percent above the poverty line, requiring more employers to offer health care options, as well as the government option, and establishing a government database to story medical records.

Here are the changes you can expect to happen within the next decade:

You have to pay

If you are not paying for insurance through your employer or out of pocket, you will soon be required to purchase health care coverage no matter what.

“You will be required to purchase insurance through an exchange or otherwise, assuming you have the means to do so,” Joseph Piemont, chief operating officer for Carolinas HealthCare System, told FoxNews.com.  “If not, it appears there will be a variety of levels of government subsidy to allow you to buy that insurance.”

However, another expert told FoxNews.com that the consequences of not purchasing health insurance will be much more severe.

“You pay the penalty and if you don’t pay the fine, you risk jail,” Dr. Elizabeth Vliet, founder of HER Place: Health Enhancement Renewal for Women, Inc. in Tucson, Ariz., told FoxNews.com.  “The penalty is going to be managed through the IRS.  You have all of the same powers that the IRS currently has to attach your property for unpaid taxes.  It’s truly draconian in what is being proposed and what has been passed in the law.”

Insurance plans

According to Piemont, patients can hope to see more basic options when it comes to choosing their health insurance.  Most likely, there will be fewer plans that cover more and more diseases and conditions – a move that is meant to allow as little discrimination as possible.

“There will be a really broad range of coverage options that haven’t existed before,” Piemont said. “What you would probably see is perhaps a narrowing of the types of benefit plans and designs that might be available in order to underpin this large scale initiative,” Piemont said.  “There’s a desire not to only expand coverage, but that there are basic benefits and uniformity there.”

However, Vliet, noted that while streamlining coverage may sound more efficient, it ultimately means patients will be paying for coverage they do not need.

“They won’t have a lot of choice of what plan to buy because the government is mandating what coverage will be approved,” Vliet said.  “It’s going to cost more, so we’re looking at health insurance premiums being quite a bit more expensive because of all the mandated coverage.

“For example, mandating fertility treatment as they do in plans in my state is rather stupid when I’m a menopausal woman and can’t get pregnant anyway,” Vliet added.  “So I have to buy a plan that covers fertility treatment when it does nothing for me.”

Changes in costs

As to how much you will pay for health care premiums,  Mike Thompson, a principal in human resource services practice of PwC, said that for the majority of Americans receiving health insurance at their jobs, not much will change.

“People who are currently getting health care through employers – this will not have a big material impact,” Thompson told FoxNews.com.  “What we know is that most employers will continue to offer coverage and offer on a subsidized basis.  They’ll keep moving towards more consumer directive type plans.  All those trends will continue, and it’s really independent of health reform.”

However, there is a broad middle class group of people that will be directly affected by the changes in terms of how much they will pay for the insurance premiums.

“There’s a group of people – those who make up to four times the poverty level, and for a family of four, that’s up $90,000 in income,” Thompson said.  “Anybody in that range, between those eligible for Medicaid and those up to 400 percent above the poverty level – what they pay for coverage will not be based on cost of coverage but their incomes.

“Finally the group that is making above 400 percent of the poverty level and not eligible for subsidies and exchanges,” Thompson continued.  “If they don’t have coverage through their employer, they have the option to buy health care, but they have to pay the full premiums.

“So the more money you make, the more you end up paying for the same coverage.”

Your medical records

Another change that will eventually go into effect is the government’s ability to seize your medical records.  In order to make information more readily available for doctors during their appointments, the government hopes to create a national database of every person’s medical history.

According to Vliet, this move is a major violation of the 5th Amendment, which prohibits the government from taking private property without just compensation.

“People don’t realize that right now – people are the owners of their medical records, and the doctors are their custodians,” Vliet said.  “When all of these new rules go into effect, everyone will be required to send records to a government database.  The biggest thing that patients will have to deal with is that government panels will be deciding their treatment and what’s allowed.  Not their treatment and not the patient.”

Screenings and Innovations

One of the most significant goals of the ACA is to foster innovations in medicine as well as ensure that the best health care is available for everyone.  According to Piemont, doctors will conduct more screenings on patients, which will help catch medical conditions earlier before they become too aggressive to cure.

“The Affordable Care Act, as it comes into effect, will require mandated screenings of everything from a physical exam to a colonoscopy,” Piemont said.  “In terms of prevention and screening, we [as health care providers] are a wonderful rescue system, the best in the world no doubt about it.  It would behoove all of us to take a little better care of ourselves.  Some of the objectives of the act are certainly congruent with what we as health care providers are best at.”

Dr. Kenneth Davis, CEO of Mount Sinai Hospital in New York City, agreed, noting that the ACA will help to ensure better health for all – not through just preventive measures but also through fostering medical breakthroughs.

“There are number of grants that facilitate innovation.  If all of that is gone, we’re going to lose tremendous momentum for patients who have multiple diagnoses and may be difficult because they live in poverty circumstances.  Thanks to a lot of the innovative grants, that leads to fewer readmissions and better health.”